How much training and work in other areas did it take you to get a job as an ER nurse?

Specialties Emergency

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I am starting work towards my BSN this fall, and as of now I want to be an ER/trauma nurse. This may change if I discover I actually can't handle that much blood (though I think I can), but that's the plan right now. When I looked into how you get a job as an ER/trauma nurse, it seemed you can't get that position as an entry-level nurse. Instead, it seems you have to work in other areas to gain experience, and sometimes work for extra certifications. How long did you have to work in other areas, and how much certification work and training did you have to do, before you were able to get a job as an ER/trauma nurse? I'm very willing to work longer to achieve this position, I just want to be informed about what it usually entails. Thank you in advance for your answers, I appreciate it!

Specializes in Psychiatric and emergency nursing.
There is much fail in this post I don't even know where to begin.

I honestly fail to see the fail in the post. I agree wholeheartedly. I started in the ER fresh out of school and have been there for four years now. I agree that the skills you learn in the ED are sometimes much different than the ones learned on the floor. I have seen med-surg nurses that can't start an IV to save his/her soul, and I have been to codes where the floor nurses seem to have absolutely no idea what's going on, much less what to do. Everyone learns at a different pace. Granted the learning curve for the ED is steep; some will sink, and some will thrive. This said, the ED is not for everyone. It takes a mastery of a basic skill set, critical thinking skills, a certain degree of autonomy, and the ability to think on your toes and change a treatment plan on a second's notice, based on the current condition of the patient. If you're truly cut out to be an ED nurse, find a good residency program with a good preceptor, and you should be just fine :)

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Specializes in Cardiac (adult), CC, Peds, MH/Substance.

Addition to what PsychNP2Be said: ED nurse residencies are becoming the norm, at least in my area. To be hired into most major EDs, you need either ED experience, or to be accepted into an ED residency. While it is possible in some cases to get ED experience without a residency, the pathway to the ED no longer seems to be getting experience in an inpatient area (med-surg or whatever), then applying for transfer. Some ED residencies in this area accept nurses with >6mo/>1yr experience. Most do not.

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Specializes in Pediatric Hematology/Oncology.
I have heard of ER residencies. Unfortunately, it seems there aren't that many of them near me. I think there's one in MA. Either that, or they just don't advertise/talk about the other ones very well. Currently, I live in central-southern MA. I'm most likely going to be going to nursing school in southern NH.

This could change while you're in nursing school. A hospital near to where I live (which is in the middle of nowhere) that was on no one's radar decided they wanted to start a Versant RN residency program toward the very end of nursing school. They hired a bunch of people from my cohort so you might luck out as many hospitals are seeing structured residency programs might be one strategy to help with retention (though I would tread carefully with going somewhere that they are just starting out any kind of residency program -- unless you are a pillar of patience). So, if you feel that ED is for you, keep residency programs on radar throughout nursing school. Become an ED tech while you're in nursing school and that will be an even bigger advantage (but please, don't be the tech that thinks they know everything -- none of the RNs will want to work with you and that will be to your disadvantage, a problem that seems common with ED techs for some reason, at least in my experience).

Here's a list of programs: http://www.aacn.nche.edu/education-resources/NRPParticipants.pdf

And, yeah, NH doesn't seem to be on the list. Don't count out relocating in order to get a decent job. It's excellent that you are thinking about this right now. A lot of nursing school is networking and building up a decent resume so that you can have a job offer before graduation. It's a hustle but it's worth it. You can basically write your own ticket and that's exactly what you want to do. Put the work in and get the job you want at the hospital you want working with people you want as coworkers. It's worth more than anything.

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At our hospital we do 2 "transitions" of New Grads...one group starts in June and the other in January. We do accept new grads to the ED straight out of school; however, there is an extensive orientation that is completed. They do several weeks as a group on the floor with one of the managers, then they are individually placed with a preceptor for a minimum of 4 months - longer if needed. In addition to the aforementioned unit training, they become certified in PALS,ACLS,NCI and participate in triage classes specifically for the ED. One thing I love about the program for our new grads, and I think is very beneficial - emergency pharmacology class. Yes, I know pharmacology is done in nursing school but pharmacology specific to the ED, and the top 200 most commonly used drugs in the ED make me feel safer and more confident with our new grads.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

In my opinion, ED nurses that start outside of the ED may have MORE difficulty learning the rhythm and flow of the ED than a new grad that starts there.

Little blood in trauma? My nine months in Afghanistan begs to differ. :D Even stateside, what is killing our trauma patients? Hemorrhage! All day long. Stopping bleeding has become a priority because we have recognized that a large percentage of our patients die from bleeding.

OP, if the ED is your goal, go for it. :)

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Specializes in Emergency.
1., there isn't that much blood. even in traumas. it happens, but it's less than you think.

2. I'm not a big fan of new nurses in the ED, especially very busy EDs. There is a lot of critical thinking that really only develops through time that one has to already have to work in the ED. I've seen medics who worked in the ED for years, go back and get their RN, and struggle in that role because of the thinking that has to happen.

Completely disagree. I was a new grad in a very busy high acuity ED with over 130,000 visits a year and am doing fine after 2 years. Most nurses that often transfer to the ED from the floor often struggle because they are too task oriented and not used to the pace/variety of the ED.

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Specializes in ED, Cardiac-step down, tele, med surg.
Completely disagree. I was a new grad in a very busy high acuity ED with over 130,000 visits a year and am doing fine after 2 years. Most nurses that often transfer to the ED from the floor often struggle because they are too task oriented and not used to the pace/variety of the ED.

I don't think this is always true. Some people do better with floor experience or other nursing experience first and some are better off without it . I don't think there's enough research to generalize. I think a good residency program will help more new grads be successful in the ED.

Though floor nursing is task oriented, I have found that the ED is also, especially if you have lower acuity patients. Dipping urines, drawing labs, discharging patients, giving meds are all tasks. There's just more of them in the ED.

I think working codes and having to stabilize higher acuity patients and getting multiple sick patients at once is where the real challenge comes in. And that part is very different from floor nursing. Some new grads will be overwhelmed if thrown into that too quickly, others not so much. Some floor nurses that have a solid skill set and flexible thinking will be able to transition more quickly to think and perform like an ED nurse.

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Specializes in Pediatric Emergency.

I started out as a new grad in my ED. I suggest that in your last year of nursing school, get to know the management of ED you want to work for. I'm sure your next question is... how do I do that? There are several ways to approach this.

- Get a senior practicum spot in that ED

- Get a part time job as an aid if they are hiring

- Voluteer

All I'm saying is get your foot in the door. Show the staff that you can become a valuble asset to the department.

If that that plan fails, apply to any RN jobs out there and suck it up for a year or 2 then apply to the desired ED. Most large ED's have high turn over rates so getting a job shouldn't be too difficult.

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1. That's good to know, thank you.

2. That makes sense. How long do you recommend working in another unit before going to the ED, and which units would you recommend?

if you get a job in the ED, it could help. Even unit secretary (my current job) allows me exposure to the environment, the nurses, docs and other staff know my work ethics, and they like to hire from within! I work p/t weekends and I love learning and seeing concepts from class applied IRL!

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I have no opinion on whether or not one should work elsewhere before going to the ED. Personally, I think the answer to that is more case by case dependent.

My one piece of advice to you- if you go straight to an ED job without having worked on a floor- is this: Learn to give decent report to the nurses you'll be sending patients to. Please.

Also, (my second piece of advice to you) weigh the patient before sending them over. We don't want any 500 lb. surprises (true story). Curse you, Brandon from ER. I would have had the bariatric everything in the room if you had given me warning. Your friendly voice over the phone was hiding so, so much.

I don't care about the dramatic tale behind why they decided to come to the hospital. I don't care how nice the patient is. I want an SBAR and if you don't know something just be honest and say so, but at least address it. I get to the point where I will cut off the tale and just start asking what I want/need to know. If you haven't checked their skin- don't tell me it's all good. I have found colostomies I've not been told about amongst all kinds of other things. If a patient has literally been down in the ED for 29 hours (another true story) you'd better be able to tell me all about them (because- by that point- it should be more than a focused assessment). Also, if the patient is not even yours, please don't give report for another nurse. I can look stuff up in the computer and find out more than you'll ever tell me in that situation.

Sorry. That turned into a mini rant. I really do actually appreciate what you all do and realize it's a different focus. Just give decent report and weigh folks. That's all I'm asking. :)

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Also, if the patient is not even yours, please don't give report for another nurse. I can look stuff up in the computer and find out more than you'll ever tell me in that situation.

Sorry. That turned into a mini rant. I really do actually appreciate what you all do and realize it's a different focus. Just give decent report and weigh folks. That's all I'm asking. :)

Unfortunately, that's the way of the ED. We have to give report on folks that we sometimes don't ever meet. In my ED, we work in partner teams and if my partner is at lunch- I have both of our patients. That means if a bed is assigned while my partner is gone, I'm giving report. That's just how it goes. I take pride in giving good reports (because I was a floor nurse first) but sometimes it just happens. And because of that, it would be nice for floor nurses to have some grace with us as well.

As far as weighing patients, yeah. That definitely doesn't happen, at least in my ED. We ask height/weight but unless you're a kiddo or getting heparin, etc, we are not weighing you. We just don't have time for that. Now, I will say if the patient is large and have a fair idea if they'll need bariatric equipment but it's not a perfect system.

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Specializes in Emergency Department.

I also started out in the ED as a new grad. Yes, it was a struggle but given time and a relatively decent orientation, transitioning to the ED should be generally doable. It's very easy to get bogged down in the ED by all the tasks that one must do with patients. Like any m/s floor, you do a LOT of tasks. Fortunately (and unfortunately) in the ED you're doing all those tasks on the fly so you might literally go from doing an assessment on one patient, a focused assessment on another, then switch to starting a line with a lab draw and hanging fluids or meds, to having to straight cath your patient... and then on top of it all, find the time to chart what you did! Med/Surg may have a reputation for being "slower" but the real difference is that there's a very different flow to things in the ED. Once you get the feel of that flow, things become easier for you. Codes do have a rhythm to them. A good team leader (usually the Doc) can set a good rhythm and tone and things will often run quite smoothly. Same with traumas big or small.

How much training did I get before going into the ED? Strictly speaking, none. That being said, I am also a Paramedic, so I already had ACLS, PALS, PHTLS, etc... The biggest change for me? Having to learn time management to take care of 4 patients at a time where I was used to taking care of just one or two patients at a time normally. Paramedics can and do easily anticipate needs if they've been exposed to the need for it but I think it's the time management that causes them to basically drown themselves at first.

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